Human adenovirus load in respiratory tract secretions are predictors for disease severity in children with human adenovirus pneumonia

Xie, Le-Yun; Zhang, Bing; Zhou, Jianli; Huang, Han; Zeng, Saizhen; Liu, Qin; Xie, Zhiping; Gao, Han‐chun; Duan, Zhaojun; Zhao, Lili

doi:10.1186/s12985-018-1037-0

Cited by 50 publications

(63 citation statements)

References 30 publications

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“…This results indicate the importance of the use of a nucleic acid-based test for routine diagnosis of adenovirus infection. Adenovirus is an important respiratory pathogen, and the positive rate (78.13%) in our study was significantly higher than that (13.3%) in Hunan [18], which may be related to the number of specimens and selected patients in our study. Furthermore, culture and mNGS were equally sensitive, as only one case of H. influenzae was missed by mNGS.…”

Section: Discussioncontrasting

confidence: 66%

Clinical diagnostic application of metagenomic next-generation sequencing in children with severe nonresponding pneumonia

et al. 2020

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Pneumonia is one of the most important causes of morbidity and mortality in children. Identification and characterization of pathogens that cause infections are crucial for accurate treatment and accelerated recovery. However, in most cases, the causative agent cannot be identified, which is partly due to the limited spectrum of pathogens covered by current diagnostics based on nucleic acid amplification. Therefore, in this study, we explored the application of metagenomic next-generation sequencing (mNGS) for the diagnosis of children with severe pneumonia. From April to July 2017, 32 hospitalized children with severe nonresponding pneumonia in Shenzhen Children's Hospital were included in this study. Blood tests were conducted immediately after hospitalization to assess cell counts and inflammatory markers, oropharyngeal swabs were collected to identify common pathogens by qPCR and culture. After bronchoscopy, bronchoalveolar lavage fluid (BALF) samples were collected for further pathogen identification using standardized diagnostic tests and mNGS. Blood tests were normal in 3 of the 32 children. In 9 oropharyngeal swabs, bacterial pathogens were detected, in 5 of these Mycoplasma pneumoniae was detected. Adenovirus was detected in 5 BALF samples, using the Direct Immunofluorescence Assay (DFA). In 15 cases, no common pathogens were found in BALF samples, using the current standard diagnostic tests, while in all 32 BALFs, pathogens were identified using mNGS, including adenovirus, Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, cytomegalovirus and bocavirus. This study shows that, with mNGS, the sensitivity of detection of the causative pathogens in children with severe nonresponding pneumonia is significantly improved. In addition, mNGS gives more strain specific information, helps to identify new pathogens and could potentially help to trace and control outbreaks. In this study, we have shown that it is possible to have the results within 24 hours, making the application of mNGS feasible for clinical diagnostics.

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Section: Discussioncontrasting

confidence: 66%

Clinical diagnostic application of metagenomic next-generation sequencing in children with severe nonresponding pneumonia

et al. 2020

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“…Most adenovirus infections are self-limited, while pneumonia is the most serious disease caused by HAdV infection in children ( Shi et al, 2020 ). The severity of HAdV infection is significantly correlated with serotype ( Xie et al, 2018b ). Compared with infected HAdV-3, children infected with HAdV-7 had a higher incidence of severe pneumonia, higher requirement for oxygen, and a longer length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

The Epidemiology, Molecular, and Clinical of Human Adenoviruses in Children Hospitalized With Acute Respiratory Infections

et al. 2021

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IntroductionHuman adenovirus (HAdV) is a common pathogen in children with acute respiratory infections (ARIs). The aim was to describe the epidemiology, molecular, and clinical characteristics of HAdV among children hospitalized with ARIs in Wenzhou in southeastern China.MethodologyFrom January 2018 to December 2019, nasopharyngeal swab or sputum specimens were prospectively collected from hospitalized children with ARIs. HAdV was detected using direct immunofluorescence. We used a multiplex PCR assay combined with capillary electrophoresis targeting the hexon gene’s hypervariable region to identify HAdV types 1, 2, 3, 4, 5, 7, 14, 21, 37, 40, 41, and 55. We analyzed the epidemiological, molecular, and clinical data according to the HAdV type.ResultsHAdVs were detected in 1,059 (3.5%) of the total of 30,543 children tested. A total of 947 cases with monotype HAdV identified by the PCR assay were included in the analysis. HAdV-3 (415/947, 43.8%), HAdV-7 (318/947, 33.6%), HAdV-2 (108/947, 11.4%), and HAdV-1 (70/947, 7.4%) were the predominant types. Of the 550 (58.1%) cases detected from December 2018 to August 2019, HAdV-3, and HAdV-7 were the main types. The main diagnoses included 358 cases of pneumonia, 232 cases of tonsillitis, 198 cases of bronchitis, and 159 cases of upper respiratory tract infection (URTI). Among children with pneumonia the main types were HAdV-7 (51.1%), HAdV-3 (36.9%), and HAdV-1 (2.2%). Among children with bronchitis, the main types were HAdV-3 (48.0%), HAdV-7 (28.3%), and HAdV-2 (10.6%). Among children with URTIs, the main types were HAdV-3 (49.7%), HAdV-7 (22.6%), and HAdV-2 (13.2%). Among children with tonsillitis, the main types were HAdV-3 (47.4%), HAdV-2 (22.4%), and HAdV-7 (18.5%). In total, 101 (55.2%) patients required supplemental oxygen, 15 (8.2%) required critical care, and 1 child (0.5%) with HAdV-7 pneumonia died.ConclusionHAdV-3 -7, -2, and -1 were the predominant types identified in hospitalized children with ARIs in Wenzhou. From December 2018 to August 2019, there were outbreaks of HAdV-3 and -7. There were significant differences in HAdV types among children with pneumonia, tonsillitis, bronchitis, and URTI. HAdV-7 can cause more severe pneumonia in children than HAdV-3.

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“…Because the severity of adenovirus pneumonia in children varies, we explored tools that could be used to predict the severity of this disease and guide management decisions. A previous study of immunocompetent children showed that adenovirus load in respiratory tract secretions was a predictor of the severity of adenovirus pneumonia [ 8 ]. Other previous studies in immunocompromised children have demonstrated an association between adenovirus viremia and disease severity [ 3 – 5 ].…”

Section: Discussionmentioning

confidence: 99%

Adenovirus viremia may predict adenovirus pneumonia severity in immunocompetent children

et al. 2021

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Background Previous studies have demonstrated an association between adenovirus viremia and disease severity in immunocompromised children. However, few studies have focused on this association in immunocompetent children. This study explored the association between adenovirus viremia and adenovirus pneumonia severity in immunocompetent children. Methods We performed a retrospective, observational study of immunocompetent children with adenovirus pneumonia admitted to Shenzhen Children’s Hospital in Shenzhen, China. Pneumonia was classified as severe or mild based on the Chinese guideline for the classification of pneumonia severity. Serum samples from all the children included in the study were tested for adenovirus DNA with a quantitative polymerase chain reaction. Clinical manifestations, laboratory examinations, and disease severity were compared between children with severe and mild pneumonia. Results A total of 111 immunocompetent children with adenovirus pneumonia (60 severe, 51 mild) were included. The median age was 40 months, and 64 patients were male. Five patients were admitted to the intensive care unit, and two underwent endotracheal intubation. All patients were discharged after recovery or improvement. Univariate analysis and binary logistic regression analysis showed that leukocytosis (OR = 1.1; 95% CI: 1.0 to 1.2; P = 0.033), co-infection with Mycoplasma pneumoniae (OR = 5.0; 95% CI: 2.1 to 12.3; P < 0.001), and high blood viral load (OR = 1.5; 95% CI: 1.2 to 2.0; P = 0.001) may be risk factors for severe adenovirus pneumonia. Conclusions Leukocytosis, co-infection with Mycoplasma pneumoniae, and high blood viral load may be risk factors for severe adenovirus pneumonia in immunocompetent children. Blood viral load may predict pneumonia severity.

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Human adenovirus load in respiratory tract secretions are predictors for disease severity in children with human adenovirus pneumonia

Cited by 50 publications

References 30 publications

Clinical diagnostic application of metagenomic next-generation sequencing in children with severe nonresponding pneumonia

Clinical diagnostic application of metagenomic next-generation sequencing in children with severe nonresponding pneumonia

The Epidemiology, Molecular, and Clinical of Human Adenoviruses in Children Hospitalized With Acute Respiratory Infections

Adenovirus viremia may predict adenovirus pneumonia severity in immunocompetent children

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